Cardiopulmonary resuscitation

Cardiopulmonary resuscitationMANALI H. SOLANKIS.Y M.Sc.NURSINGJ G COLLEGE OF NURSING

INTRODUCTION Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone's breathing or heartbeat has stopped.

ANATOMY AND PHYSIOLOGY:

DEFINITIONCardio Pulmonary Resuscitation is a technique of basic life support for oxygenating the brain and heart until appropriate, definitive medical treatment can restore normal heart and ventilatory action.

PURPOSESTo maintain an open and clear airway (A).To maintain breathing by external ventilation (B).To maintain Blood circulation by external cardiac massages (C).To save life of the Patient.To provide basic life support till medical and advanced life support arrives.

INDICATIONCardiac ArrestVentricular fibrillation (VF)Ventricular tachycardia (VT)AsystolePulse less electrical activity

Respiratory ArresstThis may be result of following:DrowningStrokeForeign body in throatSmoke inhalationDrug overdoseSuffocationAccident, injuryComaEpiglottis paralysis.

Principles of CPR

To restore effective circulation and ventilation.To prevent irreversible cerebral damage due to anoxia. When the heart fails to maintain the cerebral circulation for approximately four minutes the brain may suffer irreversible damage.

CPR procedureSEQUENCES OF PROCEDURES PERFORMED TO RESTORE THE CIRCULATION OF OXYGENATED BLOOD AFTER A SUDDEN PULMONARY AND/OR CARDIAC ARREST

CHEST COMPRESSIONS AND PULMONARY VENTILATION PERFORMED BY ANYONE WHO KNOWS HOW TO DO IT, ANYWHERE, IMMEDIATELY, WITHOUT ANY OTHER EQUIPMENT

Approach safelyCheck responseShout for helpOpen airwayCheck breathingCall 10830 chest compressions2 rescue breaths

11APPROACH SAFELY!WATCH OBSERVE

Approach safelyCheck responseShout for helpOpen airwayCheck breathingCall 10830 chest compressions2 rescue breaths

12CHECK RESPONSEApproach safelyCheck responseShout for helpOpen airwayCheck breathingCall 11230 chest compressions2 rescue breaths

13Shake shoulders gentlyAsk Are you all right?If he responds Leave as you find him. Find out what is wrong. Reassess regularly.CHECK RESPONSE

14SHOUT FOR HELPApproach safelyCheck responseShout for helpOpen airwayCheck breathingCall 11230 chest compressions2 rescue breaths

15OPEN AIRWAYApproach safelyCheck responseShout for helpOpen airwayCheck breathingCall 11230 chest compressions2 rescue breaths

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OPEN AIRWAYHead tilt and chin lift- lay rescuers- non-healthcare rescuers

No need for finger sweep unless solid material can be seen in the airway

OPEN AIRWAY

Head tilt, chin lift + jaw thrust

CHECK BREATHINGApproach safelyCheck responseShout for helpOpen airwayCheck breathingCall 10830 chest compressions2 rescue breaths

19CHECK BREATHINGLook, listen and feel for NORMAL breathing

Do not confuse agonal breathing with NORMAL breathing

20AGONAL BREATHINGOccurs shortly after the heart stops in up to 40% of cardiac arrests

Described as barely, heavy, noisy or gasping breathing

Recognise as a sign of cardiac arrest

21Approach safelyCheck responseShout for helpOpen airwayCheck breathingCall 10830 chest compressions2 rescue breaths

2230 CHEST COMPRESSIONSApproach safelyCheck responseShout for helpOpen airwayCheck breathingCall 108

30 chest compressions2 rescue breaths

23Place the heel of one hand in the centre of the chestPlace other hand on top Interlock fingersCompress the chestRate 100 min-1Depth 4-5 cm (1.5 to 2 inch)Equal compression : relaxationWhen possible change CPR operator every 2 minCHEST COMPRESSIONS

24RESCUE BREATHSApproach safelyCheck responseShout for helpOpen airwayCheck breathingCall 11230 chest compressions2 rescue breaths

25RESCUE BREATHSPinch the noseTake a normal breathPlace lips over mouthBlow until the chest risesTake about 1 secondAllow chest to fallRepeat

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RESCUE BREATHSRECOMMENDATIONS:- Tidal volume 500 600 ml

- Respiratory rate give each breaths over about 1s with enough volume to make the victims chest rise

- Chest-compression-only continuously at a rate of 100 min

CONTINUE CPR 302

28POSSIBLE COMPLICATIONS

Coronary vessel injuryDiaphragm injuryHemopericardiumHemothoraxInterference with ventilationLiver injuryMyocardial injuryPneumothoraxRib fracturesSpleen injurySternal fractureMEDICAL MANAGEMENTAdrenalineAdrenaline (epinephrine) is the main drug used during resuscitation from cardiac arrest. AtropineAtropine as a single dose of 3mg is sufficient to block vagal tone completely and should be used once in cases of asystole. It is also indicated for symptomatic bradycardia in a dose of 0.5mg - 1mg.AmiodaroneIt is an antiarrhythmic drug. NURSING MANAGEMENTMaintains airway patency with use of airway adjuncts as required (suction, high flow oxygen with O2 or bag valve mask ventilation).Assist with intubation and securing of ETTInserts gastric tube and/or facilitates gastric decompression post intubation as required.Assists with ongoing management of airway patency and adequate ventilation

Supports less experienced staff by coaching/guidance e.g. drug preparationIf a shockable rhythm is present (VF/VT) ensure manual defibrillator pads are applied and connected.If CPR is in progress, prepare and independently double check and label 3 doses of adrenalinePrepare and administer IV fluidsDocument medications administered (including time)